Knowledge, attitudes and self-perceived competencies on palliative care among medical officers at National Cancer Institute, Sri Lanka.

Introduction: Though palliative care is an essential component in the continuum of cancer care, it is still at an evolving phase in Sri Lanka. Objective: To identify knowledge, attitude, self-perceived competencies in practicing palliative care and factors associated among medical officers in National Cancer Institute, Sri Lanka. Methods: A descriptive cross sectional study was conducted among doctors in National Cancer Institute in 2020/21 using self-administered questionnaire to assess knowledge, attitudes and self-perceived competencies on palliative care. Doctors worked less than 3 months and directly not involved in patient care were excluded. Scoring systems were used to assess knowledge, attitudes and self-perceived competencies. A descriptive analysis of data was done using SPSS 21 using median scores, frequencies and chi- square test. Ethical clearance was taken from the Ethical Review Committee, Faculty of Medicine, University of Colombo. Results: Out of 120 doctors included in the study, 83 (69.3%) were females and 37 (30.7%) were males. Majority 101(84.2%) were Sinhalese. Sixty (60%) were 31-40 years. Eleven (9.2%) had training in service. Five (4.2%) had a percentage score for knowledge ≤50 while 57 (47.5%) had > 75. Only 3 (2.5%) had a percentage score for attitudes of 51-75 while 116 (96.7%) had > 75. For competency level 57 (47.5%) had percentage score ≤50 while 23 (19.2%) had > 75. Ethnicity, age, work experience, receiving undergraduate training were not significantly associated with knowledge, attitudes and practices (p > .05). Conclusion: Though level of knowledge and attitudes were high, self -perceived competencies were low which highlights the need of training in palliative care. Eg: undergraduate curricular and in-service.

Sri Lankan-born women who have given birth in Victoria: a survey of their primary postpartum health-care needs.

Women who migrate are vulnerable after giving birth. Normal postpartum adaptive challenges are heightened by separation from family and lack of familiarity with local services. The aim was to investigate primary care needs among Sri Lankan-born women with at least one Victorian-born child aged under 2 years. Health care, information and support needs and unmet needs were assessed in a structured Sinhala or English survey offered in print, online or by telephone. Fifty women provided data. Most (80%) had at least one relative from Sri Lanka to stay for postpartum support. Despite this, many had difficulties settling (62%), feeding (58%) and soothing (42%) their babies. They used significantly fewer health services on average (2.3) than mothers in the general community (2.8) (P<0.004). Only 32% of primiparous women attended at least one First-Time Parents' group session. Of women experiencing infant care difficulties, only two-thirds accessed care from a Maternal and Child Health Nurse and only one-third from a General Practitioner. Sri Lankan-born mothers have significant unmet needs for primary care, which are not reduced by informal support. A two-pronged approach is indicated in which women are informed about primary care availability, and the cultural competence and client friendliness of services is strengthened.

Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: a systematic review of the evidence.

BACKGROUND: Women of reproductive age constitute a significant proportion of immigrants from South Asia to high-income countries. Pregnancy, childbirth and the postpartum period place increased demands on women׳s psychological resources and relationships. The aim of this review was to evaluate the available evidence about the prevalence, nature and determinants of postpartum mental health problems among South Asian women who have migrated to high-income countries. METHODS: Using a systematic strategy, CINAHL, Medline, PsychInfo and Web of Science databases were searched. RESULTS: Fifteen studies conducted in different high-income countries met inclusion criteria. Prevalence estimates of clinically significant symptoms of postpartum depression (CSS-PPD) varied widely (1.9-52%): the most common estimates ranged from 5 to 20%. Five studies found approximately a two-fold increase in risk of CSS-PPD (Odds Ratios 1.8-2.5) among overseas born women with a South Asian subgroup. The most common determinants appeared to be social factors, including social isolation and quality of relationship with the partner. Barriers to accessing health care included lack of English language proficiency, unfamiliarity with local services and lack of attention to mental health and cultural factors by health care providers. LIMITATIONS: The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in these studies varied widely. Many of these studies did not use formally validated tools or undertake specific subgroup analyses. CONCLUSIONS: Reductions in postpartum depression could be achieved by increasing awareness of available services and ensuring health care professionals support the mental health of women from diverse cultural and linguistic backgrounds.